Single-center experience with the ClotTriever BOLD catheter for deep vein thrombosis percutaneous mechanical thrombectomy of the lower extremity.

Background: The ClotTriever System is a percutaneous mechanical thrombectomy system used to treat deep vein thrombosis (DVT). The BOLD catheter is a newer compatible component with a modified coring element for which reported outcomes are limited. This retrospective study aims to assess the preliminary procedural safety and success data for patients treated with the BOLD catheter. Methods: All consecutive patients with symptomatic lower extremity DVT who underwent thrombectomy with the BOLD catheter between 23 November 2021 and 26 June 2022 at a single center were included. Baseline and procedural characteristics were reported. The primary outcome, intraprocedural safety, was assessed by a chart review of recorded intraprocedural adverse events (AEs) or device malfunction. The secondary outcome, procedural success, was defined as ≥75% reduction in the total occlusion across treated venous segments. This was assessed by an interventionalist review of pre- and postprocedural venograms. Additional outcomes included length of postprocedural hospital stay and assessment of AEs at discharge and a 30-day follow-up visit. Results: Eleven patient cases were reviewed. The median patient age was 65 years, the majority were women, and all were treated unilaterally. All procedures were completed in a single session without intraprocedural AEs or device malfunction. The median procedural blood loss was 50 ml. A review of pre- and postprocedural venograms showed that 35 venous segments were treated, including the femoral (n = 9), common femoral (n = 9), external iliac (n = 10), and common iliac (n = 7) veins. Procedural success was achieved in 10 patients (90.9%), and the median reduction rate in venous occlusion was 100%. The median length of postprocedural hospital stay was 1 day, and no AEs were noted at discharge (N = 11). One adverse event occurred among the eight patients who completed their follow-up visit. A patient with advanced-stage cancer and medication failure had a recurrent DVT 13 days postprocedure, which was not related to the device or procedure. Conclusions: No safety concerns concerning the BOLD catheter were raised during the review of the cases included in this analysis, and the device was successful in reducing venous occlusion in patients with symptomatic proximal lower extremity DVT.

Expression of microRNAs and their target genes in melanomas originating from gynecologic sites.

Melanomas from gynecologic sites (MOGS) are rare and have poor survival. MicroRNAs (miRs) regulate gene expression and are dysregulated in cancer. We hypothesized that MOGS would display unique miR and mRNA expression profiles. The miR and mRNA expression profile in RNA from formalin fixed, paraffin embedded vaginal melanomas (relative to vaginal mucosa) and vulvar melanomas (relative to cutaneous melanoma) were measured with the Nanostring Human miRNA assay and Tumor Signaling mRNA assay. Differential patterns of expression were identified for 21 miRs in vaginal and 47 miRs in vulvar melanoma (fold change >2, p<0.01). In vaginal melanoma, miR-145-5p (tumor suppressor targeting TLR4, NRAS) was downregulated and miR-106a-5p, miR-17-5p, miR-20b-5p (members of miR-17-92 cluster) were upregulated. In vulvar melanoma, known tumor suppressors miR-200b-3p and miR-200a-3p were downregulated, and miR-20a-5p and miR-19b-3p, from the miR-17-92 cluster, were upregulated. Pathway analysis showed an enrichment of "proteoglycans in cancer". Among differentially expressed mRNAs, topoisomerase IIα (TOP2A) was upregulated in both MOGS. Gene targets of dysregulated miRs were identified using publicly available databases and Pearson correlations. In vaginal melanoma, suppressor of cytokine signaling 3 (SOCS3) was downregulated, was a validated target of miR-19b-3p and miR-20a-5p and trended toward a significant inverse Pearson correlation with miR-19b-3p (p = 0.093). In vulvar melanoma, cyclin dependent kinase inhibitor 1A (CDKN1A) was downregulated, was the validated target of 22 upregulated miRs, and had a significant inverse Pearson correlation with miR-503-5p, miR-130a-3p, and miR-20a-5p (0.005 < p < 0.026). These findings support microRNAs as mediators of gene expression in MOGS.

Immediate-sustained lactate release using alginate hydrogel assembled to proteinase K/polymer electrospun fibers.

This work proposes a microfibers-hydrogel assembled composite as delivery vehicle able to combine into a single system both burst and prolonged release of lactate. The prolonged release of lactate has been achieved by electrospinning a mixture of polylactic acid and proteinase K (26.0 mg of proteinase K and 0.99 g of PLA dissolved in 6 mL of 2:1 chloroform:acetone in the optimal case), which is a protease that catalyzes the degradation of polylactic acid into lactate. The degradation of microfibers into lactate reflects that proteinase K preserves its enzymatic activity even after the electrospinning process because of the mild operational conditions used. Besides, burst release is obtained from the lactate-loaded alginate hydrogel. The successful assembly between the lactate-loaded hydrogel and the polylactic acid/proteinase K fibers has been favored by applying a low-pressure (0.3 mbar at 300 W) oxygen plasma treatment, which transforms hydrophobic fibers into hydrophilic while the enzymatic activity is still maintained. The composite displays both fast (< 24 h) and sustained (> 10 days) lactate release, and allows the modulation of the release by adjusting either the amount of loaded lactate or the amount of active enzyme.

Repurposed Effect of 177Lu-DOTATATE in the Treatment of Mantle Cell Lymphoma.

Mantle cell lymphoma (MCL) is an uncommon subcategory of non-Hodgkin lymphoma (NHL). Pathogenesis primarily includes overexpression of CCND1 and SOX11 along with other molecular aberrations. Lutetium 177Lu-DOTATATE is a radiolabeled somatostatin analogue used for the treatment of gastrointestinal neuroendocrine tumors. There are no clinical data supporting the use of Lutetium 177Lu-DOTATATE in the treatment of lymphoma. We describe the case of an 84-year-old man with a history of MCL and carcinoid tumor of the lung. Following progression of the carcinoid malignancy, the patient was treated with Lutetium 177Lu-DOTATATE. After treatment, there was an overall improvement of the patient's MCL that was demonstrated by stable lymphadenopathy on serial CT scans and down-trend of the absolute lymphocyte count. Therefore, we hypothesize that 177Lu-DOTATATE might have a role and can be repurposed for treating MCL.

Self-assembly pathways in a triphenylalanine peptide capped with aromatic groups.

Peptide derivatives and, most specifically, their self-assembled supramolecular structures are being considered in the design of novel biofunctional materials. Although the self-assembly of triphenylalanine homopeptides has been found to be more versatile than that of homopeptides containing an even number of residues (i.e. diphenylalanine and tetraphenylalanine), only uncapped triphenylalanine (FFF) and a highly aromatic analog blocked at both the N- and C-termini with fluorenyl-containing groups (Fmoc-FFF-OFm), have been deeply studied before. In this work, we have examined the self-assembly of a triphenylalanine derivative bearing 9-fluorenylmethyloxycarbonyl and benzyl ester end-capping groups at the N- and C-termini, respectively (Fmoc-FFF-OBzl). The antiparallel arrangement clearly dominates in ß-sheets formed by Fmoc-FFF-OBzl, whereas the parallel and antiparallel dispositions are almost isoenergetic in Fmoc-FFF-OFm ß-sheets and the parallel one is slightly favored for FFF. The effects of both the peptide concentration and the medium on the self-assembly process have been examined considering Fmoc-FFF-OBzl solutions in a wide variety of solvent:co-solvent mixtures. In addition, Fmoc-FFF-OBzl supramolecular structures have been compared to those obtained for FFF and Fmoc-FFF-OFm under identical experimental conditions. The strength of π-π stacking interactions involving the end-capping groups plays a crucial role in the nucleation and growth of supramolecular structures, which determines the resulting morphology. Finally, the influence of a non-invasive external stimulus, ultrasounds, on the nucleation and growth of supramolecular structures has been examined. Overall, FFF-based peptides provide a wide range of supramolecular structures that can be of interest in the biotechnological field.

Resection Status Does Not Impact Recurrence in Well-Differentiated Liposarcoma of the Extremity.

BACKGROUND: Well-differentiated liposarcoma (WDLPS) is a low-grade soft tissue sarcoma with a propensity for local recurrence. The necessity of obtaining microscopically free surgical margins (R0) to minimize local recurrence is not clear. This study evaluates recurrence-free survival (RFS) of extremity WDLPS in relation to resection margin status. METHODS: A retrospective review of adult patients with primary extremity WDLPS at seven US institutions from 2000 to 2016 was performed. Patients with recurrent tumors or incomplete resection (R2) were excluded. Clinicopathologic factors were analyzed to assess impact on local RFS. RESULTS: 97 patients with primary extremity WDLPS were identified. The majority of patients had deep, lower extremity tumors. Mean tumor size was 18.2±8.9cm. Patients were treated with either radical (76.3%) or excisional (23.7%) resections; 64% had R0 and 36% had microscopically positive (R1) resection margins. Ten patients received radiation therapy with no difference in receipt of radiation between R0 vs R1 groups. Thirteen patients (13%) developed a local recurrence with no difference in RFS between R0 vs R1 resection. Five-year RFS was 59.5% for R0 vs 85.2% for R1. Only one patient died of disease after developing dedifferentiation and distant metastasis despite originally having an R0 resection. DISCUSSION: In this large multi-institutional study of surgical resection of extremity WDLPS, microscopically positive margins were not associated with an increased risk of recurrence. Positive microscopic margin resection for extremity WDLPS may yield similar rates of local control while avoiding a radical approach to obtain microscopically negative margins.

Effect of Immune Checkpoint Blockade on Myeloid-Derived Suppressor Cell Populations in Patients With Melanoma.

Introduction: Myeloid-derived suppressor cells (MDSC) are a subset of immature myeloid cells that inhibit anti-tumor immunity and contribute to immune therapy resistance. MDSC populations were measured in melanoma patients receiving immune checkpoint inhibitors (ICI). Methods: Patients with melanoma (n=128) provided blood samples at baseline (BL), and before cycles 2 and 3 (BC2, BC3). Peripheral blood mononuclear cells (PBMC) were analyzed for MDSC (CD33+/CD11b+/HLA- DRlo/-) and MDSC subsets, monocytic (CD14+, M-MDSC), granulocytic (CD15+, PMN-MDSC), and early (CD14-/CD15-, E-MDSC) via flow cytometry. Statistical analysis employed unpaired and paired t-tests across and within patient cohorts. Results: Levels of MDSC as a percentage of PBMC increased during ICI (BL: 9.2 ± 1.0% to BC3: 23.6 ± 1.9%, p<0.0001), and patients who developed progressive disease (PD) had higher baseline MDSC. In patients who had a complete or partial response (CR, PR), total MDSC levels rose dramatically and plateaued (BL: 6.4 ± 1.4%, BC2: 26.2 ± 4.2%, BC3: 27.5 ± 4.4%; p<0.0001), whereas MDSC rose less sharply in PD patients (BL: 11.7 ± 2.1%, BC2: 18.3 ± 3.1%, BC3: 19.0 ± 3.2%; p=0.1952). Subset analysis showed that within the expanding MDSC population, PMN-MDSC and E-MDSC levels decreased, while the proportion of M-MDSC remained constant during ICI. In PD patients, the proportion of PMN-MDSC (as a percentage of total MDSC) decreased (BL: 25.1 ± 4.7%, BC2: 16.1 ± 5.2%, BC3: 8.6 ± 1.8%; p=0.0105), whereas a heretofore under-characterized CD14+/CD15+ double positive MDSC subpopulation increased significantly (BL: 8.7 ± 1.4% to BC3: 26.9 ± 4.9%; p=0.0425). Conclusions: MDSC levels initially increased significantly in responders. PMN-MDSC decreased and CD14+CD15+ MDSC increased significantly in PD patients. Changes in MDSC levels may have prognostic value in ICI.

Salud en personas mayores afrodescendientes Chilenas / Health in older people of african-descendant in Chile

Chile recientemente ha reconocido al pueblo tribal afrodescendiente, se trata de un colectivo poco estudiado y con severas desventajas sociales y sanitarias. Este estudio tiene como objetivo describir el perfil de salud y el acceso a servicios sanitarios, junto con analizar la asociación entre las variables sociodemográficas, de salud y los síntomas depresivos en personas mayores afrodescendientes. Estudio piloto que contó con la participación de 60 personas mayores afrodescendientes, se aplicaron diversas escalas de valoración geriátrica. Los antecedentes de salud indicarían que el 78% es hipertenso, 57% tiene síntomas depresivos, el 30% es independiente en actividades de la vida diaria (AVD), y un 61% tiene riesgo leve de caídas. Respecto al acceso a salud: 84% está inscrito en un centro de salud, el 68% es beneficiario del programa de salud cardiovascular y un 71% está al día con la vacuna preventiva de la influenza. Las variables predictivas de depresión son ser beneficiario del programa de alimentación complementaria y la dependencia en AVD. Este estudio ratifica la relevancia de la inclusión de patologías específicas concorde al perfil epidemiológico de los grupos étnicos-raciales y seguir avanzando en estudios sanitarios específicos en minorías étnicas.

Chile has recently recognized the Afrodescendant tribal people, a little studied group with severe social and health disadvantages. This study aims to describe the health profile and access to health services, and to analyze the association between sociodemographic and health variables and depressive symptoms in older people of African descent. Pilot study with the participation of 60 elderly people of African descent, with the application of several geriatric assessment scales. Health history indicated that 78% are hypertensive, 57% have depressive symptoms, 59% are independent in activities of daily living (ADL), and 61% have a slight risk of falling. Regarding access to health care: 84% are enrolled in a health center, 68% are beneficiaries of the cardiovascular health program and 71% are up to date with the preventive influenza vaccine. The variables predictive of depression are being a beneficiary of the complementary feeding program and dependence in ADLs. Conclusion: This study ratifies the relevance of including specific pathologies according to the epidemiological profile of ethnic-racial groups and to continue advancing in specific health studies in ethnic minorities.

Antibody Conjugation of Fluorescent Nanodiamonds for Targeted Innate Immune Cell Activation.

BACKGROUND: fluorescent nanodiamonds (FND) are nontoxic, infinitely photostable nanoparticles that emit near-infrared fluorescence and have a modifiable surface allowing for the generation of protein-FND conjugates. FND-mediated immune cell targeting may serve as a strategy to visualize immune cells and promote immune cell activation. METHODS: uncoated-FND (uFND) were fabricated, coated with glycidol (gFND), and conjugated with immunoglobulin G (IgG-gFND). In vitro studies were performed using a breast cancer/natural killer/monocyte co-culture system, and in vivo studies were performed using a breast cancer mouse model. RESULTS: in vitro studies demonstrated the targeted immune cell uptake of IgG-gFND, resulting in significant immune cell activation and no compromise in immune cell viability. IgG-gFND remained at the tumor site following intratumoral injection compared to uFND which migrated to the liver and kidneys. CONCLUSION: antibody-conjugated FND may serve as immune drug delivery vehicles with "track and trace capabilities" to promote directed antitumor activity and minimize systemic toxicities.

Amphibians of Serra das Torres Natural Monument: a reservoir of biodiversity in the Atlantic Forest of southeastern Brazil / Anfíbios do Monumento Natural Serra das Torres: um reservatório da biodiversidade da Mata Atlântica no sudeste do Brasil

Abstract The Brazilian Atlantic Forest holds a major part of the country's amphibian species richness and high rates of endemism. In this study, we conducted surveys using the Rapid Assessment (RA) method to sample the amphibian fauna of the Serra das Torres Natural Monument (MONAST), an Atlantic Forest remnant in southeastern Brazil. We sampled actively with a 6-10-person team to collect standard samples from 09:00 to 12:00 hours for the daytime period, and from 18:00 to 22:00 hours for the crepuscular/nighttime period, with a total of approximately 1,320 hours of sampling effort. We supplemented these data with 720 hours of passive sampling, using pitfall traps with drift fences (30 bucket-days). We recorded 54 amphibian species (two gymnophionans and 52 anurans), and the species richness estimated by the Bootstrap method indicates that a slightly larger number of species (n = 60) may occur in the study area. The most speciose family was Hylidae (n = 21), followed by Brachycephalidae (n = 8). Overall, 25% of the species (n = 13) were recorded only once (singletons) and 15% (n = 8) only twice (doubletons). Most amphibians recorded in this study (71%, n = 37 species) were restricted to the Atlantic Forest biome, two species (Euparkerella robusta and Luetkenotyphlus fredi) are endemic to the Espírito Santo state, and one of them, the leaf litter species E. robusta, is endemic to the MONAST. Euparkerella robusta is currently listed as Vulnerable by the IUCN and is classified as Critically Endangered in the Espírito Santo State red list, while L. fredi has yet to be evaluated due to its recent description. Thoropa lutzi is currently listed as Endangered (EN) by both the IUCN and in the State list. Nine species are listed as Data Deficient (DD) and populations of 13 species are considered to be declining by the IUCN. We extend the geographical distribution of two anuran species (Hylodes babax and Phasmahyla lisbella) and fill an important gap in the distribution of Siphonops hardyi. Amphibians associated with the forest floor represented 42% of the species richness from MONAST, and 43% of these species inhabit the leaf litter exclusively. Our study revealed that Serra das Torres preserves a considerable diversity of Atlantic Forest amphibians, which reinforces the need for the conservation of this forest remnant.

Resumo A Mata Atlântica brasileira guarda importante porção da riqueza de anfíbios e altas taxas de endemismos. Neste estudo, nós realizamos pesquisas usando o Método de Avaliação Rápida (RA) com o objetivo de inventariar a fauna de anfíbios de um remanescente da Mata Atlântica no sudeste do Brasil, o Monumento Natural Serra das Torres (MONAST). Amostramos ativamente com uma equipe de 6 a 10 pessoas para coletar amostras padronizadas entre 09:00 e 12:00 horas durante o peíodo diurno e entre 18:00 e 22:00 duranto período crepuscular/noturno, totalizando aproximadamente 1320 horas de esforço amostral. Complementamos estes dados com 720 horas de amostragem passiva usando armadilhas de queda com cercas-guia (30 dias de balde). Registramos 54 espécies de anfíbios (dois gimnofionos e 52 anuros) e a riqueza de espécies estimada pelo Bootstrap indicou um número relativamente maior de espécies (n = 60). A família mais especiosa foi Hylidae (n = 21), seguida por Brachycephalidae (n = 8). No geral, 25% das espécies (n = 13) foram registradas apenas uma vez - singletons e 15% (n = 8) apenas duas vezes (doubletons). A maioria dos anfíbios registrados neste estudo (71%, n = 37 espécies) esteve restrita ao bioma Mata Atlântica, duas espécies (Euparkerella robusta e Luetkenotyphlus fredi) são endêmicas do estado do Espírito Santo, sendo uma delas, a espécie de serapilheira E. robusta, endêmica do MONAST. Euparkerella robusta está atualmente listada como Vulnerável pela IUCN e classificada como Criticamente Ameaçada na lista vermelha do estado do Espírito Santo, enquanto L. fredi ainda não foi avaliada devido a sua descrição ser muito recente. Thoropa lutzi está atualmente listada como Ameaçada (EN) pela IUCN e na lista estadual. Nove espécies estão listadas como Deficiente de Dados (DD) e as populações de 13 espécies são consideradas em declínio pela IUCN. Estendemos a distribuição geográfica de duas espécies de anuros (Hylodes babax e Phasmahyla lisbella) e preenchemos uma importante lacuna na distribuição de Siphonops hardyi. Os anfíbios associados ao chão da floresta representaram 42% das espécies do MONAST e 43% destas espécies habitavam exclusivamente a serapilheira. Nosso estudo revelou que a Serra das Torres preserva diversidade considerável de anfíbios da Mata Atlântica, o que reforça a necessidade de conservação desse remanescente florestal.

Calidad de vida en personas mayores de entornos rurales: diferencias entre hombres y mujeres

RESUMEN Objetivo: Analizar las diferencias entre hombres y mujeres en los diversos dominios de la calidad de vida (CdV) en personas mayores que residen en zonas rurales del extremo norte de Chile. Material y Método: Estudio cuantitativo, descriptivo, transversal realizado entre noviembre 2019 y febrero 2020 en diversas zonas rurales de la Región de Arica y Parinacota. Contó con un universo de 100 personas mayores de 60 años y sin deterioro cognitivo. Se aplicó el Cuestionario Breve de Calidad de Vida (CUBRECAVI). La investigación fue aprobada por la Escuela de Trabajo Social de la Universidad de Tarapacá. Resultados: 69% mujeres, 63% entre 60 y 69 años, 67% casado o en pareja y 58% indígena. Se confirman diferencias estadísticamente significativas en el dominio salud objetiva: tobillos hinchados, cansancio, dificultad para dormir, escape de orina y hormigueos; en el dominio salud psíquica: llorar con facilidad, sentimientos depresivos y problemas de memoria. Lo mismo se observa en integración social, en el nivel de satisfacción con la relación del cónyuge o pareja, con los familiares y con las amistades. Igualmente los hallazgos confirman diferencias en el dominio actividades, nivel de actividades, frecuencia camina y frecuencia hace manualidades. Por último, en el dominio calidad ambiental, en la satisfacción con la temperatura del hogar. Los resultados indican que las mujeres tienen peor CdV y las personas mayores perciben que el dominio salud es el más importante para valorar su CdV. Conclusión: Se confirma riesgo biopsicosocial para mujeres mayores que residen en zonas rurales del extremo norte de Chile. Enfermería y otras disciplinas de trato directo con las personas mayores deben conocer las distintas maneras de envejecer, diferenciando por sexo y especificidades del entorno rural.

ABSTRACT Objective: To analyze the differences between men and women in the different domains of quality of life (QoL) among elderly people living in rural areas of the north of Chile. Material and Method: Quantitative, descriptive, cross-sectional study conducted between November 2019 and February 2020 in various rural areas of the Region of Arica and Parinacota. The sample consisted of 100 people over 60 years old and without cognitive impairment. The Brief Quality of Life Questionnaire (CUBRECAVI) was applied. The research was approved by the School of Social Work of the Universidad de Tarapacá. Results: 69% were women, 63% were between 60 and 69 years old, 67% were married or had a relationship and 58% had indigenous origin. Statistically significant differences were confirmed in the objective health domain: swollen ankles, tiredness, sleep problems, urinary incontinence and tingling; in the psychic health domain: crying easily, depressive feelings and memory problems. This was similar in the field of social integration, in the level of satisfaction concerning the relationship with the spouse or partner, with family members and with friends. Moreover, the findings corroborate differences in the domain of activities, level of activities, frequency of walking and frequency of doing crafts. Finally, in the environmental quality domain, there are differences in satisfaction with room temperature. The results show that women have worse QoL and the elderly perceive that the health domain is the most important when assessing their QoL. Conclusion: There is a biopsychosocial risk for older women living in rural areas in the north of Chile. It is clear that nursing and other areas dealing directly with the elderly have to familiar with the different ways of aging, taking into account gender and specific rural setting.

RESUMO Objetivo: Analisar as diferenças entre homens e mulheres nos diversos domínios da qualidade de vida (QV) em idosos residentes em áreas rurais do norte do Chile. Material e Método: Estudo quantitativo, descritivo, transversal realizado entre novembro de 2019 e fevereiro de 2020 em diversas áreas rurais da Região de Arica e Parinacota. A amostra consistiu em 100 pessoas com mais de 60 anos e sem déficit cognitivo. Foi aplicado o Questionário Breve de Qualidade de Vida (CUBRECAVI). A pesquisa foi aprovada pela Escola de Serviço Social da Universidade de Tarapacá. Resultados: 69% eran mulheres, 63% tinham entre 60 e 69 anos, 67% estavam casadas ou tinham um relacionamento e 58% tinham origem indígena. Foram confirmadas diferenças estatisticamente significativas no dominio da saúde objetiva: tornozelos inchados, fadiga, dificuldade para dormir, perda de urina e formigamento; no domínio da saúde psíquica: choro com facilidade, sentimentos depressivos e problemas de memória. O mesmo foi observado na integração social, no nível de satisfação na relação com o cônjuge ou companheiro, com os familiares e com os amigos. Da mesma forma, os achados confirmam diferenças no domínio das atividades, nível de atividades, frequência de caminhadas e frequência de artesanato. Finalmente, no domínio da qualidade ambiental há diferenças no grau de satisfação com a temperatura da casa. Os resultados indicam que as mulheres apresentam pior QV e os idosos percebem que o domínio saúde é o mais importante para avaliar sua QV. Conclusão: O risco biopsicossocial é confirmado para mulheres idosas residentes em áreas rurais do extremo norte do Chile. A enfermagem e as demais disciplinas que lidam diretamente com o idoso devem conhecer as diferentes formas de envelhecer, diferenciando entre os sexos e as especificidades do meio rural.

Caracterización de la tuberculosis pulmonar en mayores de 15 años. Hospital de Día "Dr. Efrén Jurado López" / Characterization of pulmonary tuberculosis in over 15 years. "Dr. Efrén Jurado López Day Hospital"

La tuberculosis pulmonar constituye una enfermedad de salud pública en el territorio ecuatoriano en expansión que provoca muerte y sufrimiento para la población. El objetivo del estudio es caracterizar la tuberculosis pulmonar en individuos mayores de 15 años que asisten al Hospital de Día "Dr. Efrén Jurado López" de la ciudad de Guayaquil. Se realizó una investigación cuantitativa, descriptiva, retrospectiva. La muestra de estudio quedó conformada por 58 pacientes de ambos géneros mayores de 15 años, diagnosticados con tuberculosis en todas sus formas, atendidos en el contexto de estudio entre enero 2017 y enero de 2018. En la recolección de la información se aplicó una ficha de observación validada por expertos con previo consentimiento informado de los pacientes estudiados. Como resultados se obtuvo que el 72,4% eran del sexo masculino y el 27,6% femenino. El predominio de diagnóstico presentado fue sintomático TBP BK+ en un 100%. Por otra parte para el diagnóstico por TBP cultivo + fue 87,9% (51/58) y TBP cultivo- de 12,1% (7/58). Por otra parte la TB EP fue de 25,9% (15/58) con predominio en el sexo masculino 80%, las formas de tuberculosis y la comorbilidad asociada al al Virus de Inmunodeficiencia Humana (VIH), se observó una frecuencia de 6,9% (4/58) de personas con TB que tenían VIH, de las cuales el 5,2% correspondían a casos de VIH con tuberculosis extra pulmonar y 1,7% a casos de TBP BK+/VIH. Se debe continuar trabajando en la búsqueda de TB en pacientes sintomáticos respiratorios para un diagnóstico oportuno(AU)

Characterization of pulmonary tuberculosis in teenagers older than 15 years in thedr.Efrénjuradolópez day time hospital. Pulmonary tuberculosis is a public health disease in the expanding Ecuadorian territory that causes death and suffering for the population. The objective of the study is to characterize pulmonary tuberculosis in individuals over 15 years of age attending the "Dr. Efrén Jurado López" Day Hospital in the city of Guayaquil. A quantitative, descriptive, retrospective investigation was carried out. The study sample consisted of 58 patients of both genders over 15 years of age, diagnosed with tuberculosis in all its forms, treated in the context of the study between January 2017 and January 2018. A data sheet was applied in the collection of information observation validated by experts with prior informed consent of the patients studied. As a result, it was obtained that 72.4% were male and 27.6% female. The prevalence of diagnosis presented was symptomatic TBP BK + in 100%. On the other hand for the diagnosis by TBP culture + it was 87.9% (51/58) and TBP culture- of 12.1% (7/58). On the other hand, the TB TB was 25.9% (15/58) with a predominance in the male sex 80%, the forms of tuberculosis and the comorbidity associated with the Human Immunodeficiency Virus (HIV), a frequency of 6 was observed, 9% (4/58) of people with TB who had HIV, of which 5.2% corresponded to HIV cases with extra pulmonary tuberculosis and 1.7% to cases of BK + / HIV TBP. Work should continue in the search for TB in symptomatic respiratory patients for a timely diagnosis(AU)

Neoadjuvant radiation improves margin-negative resection rates in extremity sarcoma but not survival.

BACKGROUND AND OBJECTIVES: Radiation improves limb salvage in extremity sarcomas. Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas. MATERIALS AND METHODS: A multi-institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000-2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed. RESULTS: A total of 1483 patients were identified. Most patients receiving radiotherapy had high-grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb-sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence-free survival between the three groups (OS, P = .132; RFS, P = .227). CONCLUSION: In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin-negative resections however this did not improve local recurrence or survival rates over.

Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review.

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000-2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.

Trends in the Use of Adjuvant Chemotherapy for High-Grade Truncal and Extremity Soft Tissue Sarcomas.

BACKGROUND: In the randomized controlled trial (RCT) EORTC 62931, adjuvant chemotherapy failed to show improvement in relapse-free survival (RFS) or overall survival (OS) for patients with resected high-grade soft tissue sarcoma (STS). We evaluated whether the negative results of this 2012 RCT have influenced multidisciplinary treatment patterns for patients with high-grade STS undergoing resection at seven academic referral centers. METHODS: The U.S. Sarcoma Collaborative database was queried to identify patients who underwent curative-intent resection of primary high-grade truncal or extremity STS from 2000 to 2016. Patients with recurrent tumors, metastatic disease, and those receiving neoadjuvant chemotherapy were excluded. Patients were divided by treatment era into early (2000-2011, pre-European Organisation for Research and Treatment of Cancer [EORTC] trial) and late (2012-2016, post-EORTC trial) cohorts for analysis. Rates of adjuvant chemotherapy and clinicopathologic variables were compared between the two cohorts. Univariate and multivariate regression analyses were used to determine factors associated with OS and RFS. RESULTS: 949 patients who met inclusion criteria were identified, with 730 patients in the early cohort and 219 in the late cohort. Adjuvant chemotherapy rates were similar between the early and late cohorts (15.6% versus 14.6%; P = 0.73). Patients within the early and late cohorts demonstrated similar median OS (128 months versus median not reached, P = 0.84) and RFS (107 months versus median not reached, P = 0.94). Receipt of adjuvant chemotherapy was associated with larger tumor size (13.6 versus 8.9 cm, P < 0.001), younger age (53.3 versus 63.7 years, P < 0.001), and receipt of adjuvant radiation (P < 0.001). On multivariate regression analysis, risk factors associated with decreased OS were increasing American Society of Anesthesiologists class (P = 0.02), increasing tumor size (P < 0.001), and margin-positive resection (P = 0.01). Adjuvant chemotherapy was not associated with OS (P = 0.88). Risk factors associated with decreased RFS included increasing tumor size (P < 0.001) and margin-positive resection (P = 0.03); adjuvant chemotherapy was not associated with RFS (P = 0.23). CONCLUSIONS: Rates of adjuvant chemotherapy for resected high-grade truncal or extremity STS have not decreased over time within the U.S. Sarcoma Collaborative, despite RCT data suggesting a lack of efficacy. In this retrospective multi-institutional analysis, adjuvant chemotherapy was not associated with RFS or OS on multivariate analysis, consistent with the results from EORTC 62931. Rates of adjuvant chemotherapy for high-grade STS were low in both cohorts but may be influenced more by selection bias based on clinicopathologic variables such as tumor size, margin status, and patient age than by prospective, randomized data.

Multi-ethnic validation of 15-item Geriatric Depression Scale in Chile

Abstract Background: There has been scant research published regarding the assessment of depression in ethnic groups, and few studies have addressed the validation of scales for standardized assessment of depressive symptoms among indigenous minorities. Objective: The aim of this study was to analyze the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15) for a multi-ethnic sample of older Chilean adults.Methods: Cross-sectional study with a sample of 800 older people, 71% of whom were self-declared indigenous (Aymara/Mapuche).Results: The non-indigenous group had a higher total GDS-15 score and lower quality of life and wellbeing scores than the indigenous groups (p< 0.001). The GDS-15 had a KR-20 coefficient of 0.90 for the non-indigenous group, 0.80 for Aymara, and 0.85 for Mapuche. The homogeneity index was 0.38 for non-indigenous, 0.24 for Aymara, and 0.29 for Mapuche.Discussion: The GDS-15 showed satisfactory psychometric characteristics for the samples studied. However, the better results observed for the non-indigenous group suggest that some characteristics and content of the rating scale are not fully appropriate for the indigenous older population. Conclusions:There is a need to develop the transcultural validation of scales such as GDS-15, which are applied in a standardized manner in geriatric evaluations as part of primary healthcare.

Enfermedad de mano-pie-boca atípica causada por virus Coxsackie A6 en Argentina, 2015 / Atypical hand, foot, and mouth disease caused by Coxsackievirus A6 in Argentina in 2015

We present two groups of cases of atypical hand, foot, and mouth disease (HFMD) caused by Coxsackievirus A6 (CV-A6) detected in Argentina in 2015. The first group involved 14 patients from Chubut province and the second group affected 12 patients from San Luis province. Molecular analysis of the complete VP1 protein gene revealed the circulation of E2 sublineage, the most predominant worldwide. To our knowledge, this is the first report of CV-A6 infections associated with atypical HFMD in Argentina and South America.

Se describen dos grupos de casos de enfermedad de mano-pie-boca (HFMD) atípica causada por el virus Coxsackie A6 (Coxsackievirus A6, CV-A6) detectados en Argentina en el año 2015. El primero de los grupos involucró a 14 pacientes de Chubut y el segundo a 12 pacientes de San Luis. El análisis molecular del gen de la proteína VP1 completa reveló la circulación del sublinaje E2, el predominante a nivel global. Hasta donde sabemos, este es el primer reporte de infecciones CV-A6 asociadas con HFMD atípica en Argentina y Sudamérica.

Generation of monocyte-derived tumor-associated macrophages using tumor-conditioned media provides a novel method to study tumor-associated macrophages in vitro.

BACKGROUND: Tumor-associated macrophages (TAM) are expanded and exhibit tumor-promoting properties within the tumor microenvironment. Current methods to study TAM have not been replicated across cancer types and often do not include exogenous growth factors from the tumor, a key factor in TAM differentiation in vivo. METHODS: In this study, an in vitro method to generate monocyte- derived TAM using tumor- conditioned media (TCM) and a cytokine cocktail containing IL-4, IL-10, and M-CSF was utilized to study the phenotype, morphology, and function of TAM across multiple cancer types. TCM was generated from two breast cancer cell lines and an Epstein-Barr virus-positive lymphoma cell line. The properties of in vitro generated TAM were compared to in vitro generated M1 and M2- like macrophages and TAM isolated from patients with cancer. RESULTS: TAM generated in this fashion displayed an increase in CD163/CD206 co-expression compared to M2- like macrophages (87 and 36%, respectively). TAM generated in vitro exhibited increased transcript levels of the functional markers IL-6, IL-10, CCL2, c-Myc, iNOS, and arginase compared to in vitro generated M2-like macrophages. Functionally, in vitro generated TAM inhibited the proliferation of T cells (47% decrease from M1-like macrophages) and the production of IFN-γ by natural killer cells was inhibited (44%) when co-cultured with TAM. Furthermore, in vitro generated TAM secreted soluble factors that promote the growth and survival of tumor cells. CONCLUSIONS: Limited access to patient TAM highlights the need for methods to generate TAM in vitro. Our data confirm that monocyte-derived TAM can be generated reliably using TCM plus the cytokine cocktail of IL-4, IL-10, and M-CSF. Given the ability of TAM to inhibit immune cell function, continued study of methods to deplete or deactivate TAM in the setting of cancer are warranted.

Pharmacotherapy for liposarcoma: current state of the art and emerging systemic treatments.

Introduction: Liposarcomas are a heterogeneous group of soft tissue tumors that arise from adipose tissue and are one of the most common soft tissue sarcomas found in adults. Liposarcomas are subclassified into four subtypes with distinct histologic and biologic features that influence their treatment and management. Areas covered: This manuscript reviews the key clinicopathologic and cytogenic characteristics of the liposarcoma histologic subtypes and summarizes the results of recent clinical trials, treatment options, and future directions in the pharmacotherapy for the management of liposarcoma. Expert opinion: Despite significant advancements in the management of this disease, the treatment of liposarcoma continues to be a challenge. Surgical resection remains the mainstay of treatment for localized disease; however, use of systemic therapies in conjunction with surgery may be considered in patients where tumor shrinkage could reduce surgical morbidity and in patients with high-risk of micrometastatic disease. Anthracycline-based chemotherapy regimens remain the standard first-line treatment for unresectable/metastatic liposarcoma. Trabectedin and eribulin are currently the two most promising and evidenced-based second-line treatment options for liposarcomas. However, multiple clinical trials dedicated to patients with liposarcoma evaluating novel targeted agents are ongoing. Every effort should be made to enroll patients with liposarcoma into histotype-specific clinical trials.

Increased breast cancer risk in women with neurofibromatosis type 1: a meta-analysis and systematic review of the literature.

BACKGROUND: Neurofibromatosis type 1 (NF1) is a cancer predisposing syndrome. Studies suggest that women < 50 years old (y.o.) with NF1 have an increased breast cancer (BC) incidence and BC associated mortality. However, this has not been widely recognized secondary to small study populations. METHODS: A systematic literature review was conducted through database searches for BC and NF1: 3456 articles identified, 166 reviewed, 58 used for descriptive analysis and 4 utilized for meta-analysis. Fisher's exact tests, Kaplan-Meier curves and random-effects meta-analysis models were used for analysis. RESULTS: Two hundred eighty-six cases of NF1 and female BC were identified with a median age of 46 years at diagnosis; 53% were <  50. Peak age of BC diagnosis was between 34 to 44 years. Women < 50 y.o. presented with more advanced disease vs. those ≥50 (56% vs. 22% stage III-IV, respectively; p = 0.005). Median survival for the entire cohort was 5 years vs. the reported median BC survival of over 20 years in the general population using the SEER database. Median age at BC death was 48.5 years; 64% of deceased patients were <  50. Meta-analysis of a total of 4178 women with NF1 revealed a BC standardized incidence ratio (SIR) of 3.07 (95%CI 2.16-4.38) for women with NF1 vs. the general population. Women < 50 y.o. demonstrated a higher SIR of 5.08 (95%CI 3.77-6.81) compared to 1.92 (95%CI 1.40-2.63) if ≥50 y.o. CONCLUSIONS: This systematic literature review and meta-analysis suggests that women with NF1 <  50 y.o. have a five-fold increased risk of BC, present with more advanced disease, and may have an increased BC related mortality. Increased awareness and implementation of recent National Comprehensive Cancer Network early BC screening guidelines for this high-risk patient population is essential. Additional evaluation on the influence of NF1 gene mutations identified in patients undergoing hereditary cancer genetic testing on breast cancer risk in individuals without clinical evidence of NF1 is needed.